What's the Difference Between Alcohol Abuse and Dependence?
I was speaking with a friend of mine recently, and she protested to me that her husband had questioned her drinking habits.
“I’m not an alcoholic, I just like to unwind with a few drinks at night. I don’t need to drink, I just like to drink. Is that such a big deal!”
She continued that she was a good mom and a good employee and that was evidence enough that she didn’t have a drinking problem. She was venting more than asking for input, so I didn’t challenge her. It was a brief conversation that may not have been cause for reflection for her, but it made me realize how common misconceptions about alcohol use are. To clear some of them up, let’s start with some basic definitions.
What is alcohol dependence?
First off, it is important to note that there is a difference between the medical understanding of chemical dependence and the definition of substance dependence used by mental health practitioners. Physical dependence is simply when the body adapts to the drug resulting in drug-specific withdrawal symptoms when the drug is removed, and an increased tolerance to the effects of the drug. A person’s behavior or relationship to the drug is not a factor.
When it comes to alcohol specifically, it is hard to imagine somebody becoming physically dependent without also abusing alcohol. But, many prescription medications cause dependence as defined above even when taken as directed. The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), which is now outdated, diagnosed alcohol dependence when three or more of the following criteria were met within the past year:
- Have you had to drink more than you once did to get the same buzz? Or have you found the number of drinks you would usually have has less of an effect than before? (This question is determining if your alcohol tolerance has increased.)
- Have you found that when the effects of alcohol were wearing off, you had withdrawal symptoms of alcohol like increased anxiety/agitation, trouble sleeping, restlessness, sweating, nausea, “the shakes”, or seizures?
- Have you ended up drinking more or for longer than you had intended?
- Have you tried to cut down or stop drinking and found you couldn’t?
- Have you spent a lot of time drinking or recovering from hangovers?
- Have you given up doing the things you enjoy in favor of drinking?
- Have you continued to drink despite negative effects to your physical or mental health (like increased depression and anxiety or memory problems)?
What is alcohol abuse?
Abuse and dependence often go hand-in-hand. The same diagnostic standard defined alcohol abuse as a related, but distinct and less severe condition. Meeting one or more of the following criteria fit the diagnosis:
- Are your drinking habits hazardous? (For example, driving drunk or drinking to the point of blackout are hazardous behaviors.)
- Do you have social/interpersonal problems related to your drinking? (My aforementioned friend would answer yes here.)
- Have you neglected any of your major responsibilities to drink?
- Have you faced legal consequences as a result of your drinking?
These criteria are much more focused on the behavior surrounding your alcohol use. So, now that you understand what alcohol abuse and alcohol dependence are, let’s take a look at the key differences.
What is the difference between alcohol dependence and alcohol abuse?
- Alcohol dependence is characterized mainly by physical symptoms.
- Alcohol abuse is characterized mainly by behavioral symptoms.
- The amount of alcohol consumption and the regularity of your drinking are not factors that would exclude you from alcohol abuse.
- A successful career, a happy marriage, a clean legal record, and your well-raised children are not evidence that you do not have an alcohol dependency.
- Alcohol abuse is considered less serious than alcohol dependence.
So, does that mean that if you are a heavy drinker who fits the diagnosis for alcohol abuse that your problem is not a serious one? And if your only dependence criteria are that you have tried to quit drinking but couldn’t, and your continued binge drinking has exacerbated your depression, does that mean you don’t have a problem?
The answer to both questions is obviously, no. That is why the DSM-V has combined these diagnoses into one: alcohol use disorder. According to the National Institute on Alcohol Abuse and Alcoholism, AUD as a diagnosis, removes the stigma that was associated with the term “abuse” and has different criteria (notably removing legal trouble).
What is alcohol use disorder (AUD)?
AUD Severity Scale:
Mild = 2-3 symptoms
Moderate = 4-5 symptoms
Severe = 6 or more symptoms
According to the DSM-V, the presence of at least 2 of the following symptoms is indicative of alcohol use disorder. Each question that you answer with a yes is a symptom. The questions are, in the past year have you:
- Had times when you ended up drinking more, or longer, than you intended?
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
- Spent a lot of time drinking? Or being sick or getting over other aftereffects?
- Wanted a drink so badly you couldn’t think of anything else?
- Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
- Continued to drink even though it was causing trouble with your family or friends?
- Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
- More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
- Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
- Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?
How do I know if I have a drinking problem?
If you have answered the questions above honestly and found that you fit the diagnosis for alcohol use disorder, you had probably already considered that you may have a drinking problem. And, even if you did not meet 3 or more of the criteria, but you feel that alcohol is negatively impacting your life, then you may have a problem with alcohol. But don’t worry, there are plenty of ways that you can get help!
How do I get help for alcohol?
If you think you have a problem, the first thing you should do is consult a professional. If you are physically dependent on alcohol, they will most likely recommend an alcohol detox program. Alcohol withdrawal is not just uncomfortable, it can actually be fatal if not properly managed. If dependence is not your issue, the recommendation will vary according to the severity of your substance abuse and the presence of co-occurring disorders.
Generally speaking, these are the best options to help you quit drinking and treat your alcohol use disorder:
- Inpatient alcohol treatment
- Intensive outpatient alcohol treatment
- Alcohol counseling
- Alcohol cessation medications
- Alcoholics Anonymous
- Other non-12 step support groups like Smart Recovery and Refuge Recovery
If you have questions or would like to get help for drinking, 1 Solution Detox is just a call away. Somebody with intimate knowledge about substance use disorders is available to speak with you 24/7. We would be happy to discuss what you can expect from addiction treatment facilities, find you outpatient options, or refer you to an appropriate national helpline.